Burnout increased among university students during the COVID-19 pandemic: a systematic review and meta-analysis.

Generally, university students are at risk of burnout. This likely was exacerbated during the COVID-19 pandemic. We aimed to investigate burnout prevalence among university students during the COVID-19 pandemic and examine its distribution across countries, sexes, fields of study, and time-period. PubMed, EMBASE, PsycINFO, World Health Organization's Global COVID-19 database, Scopus, Epistemonikos, ERIC and Google Scholar were searched (protocol: https://doi.org/10.17605/OSF.IO/BYRXW ). Studies were independently screened and extracted. Random-effects meta-analysis was performed. Study quality was appraised, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We identified 44 primary studies comprising 26,500 students. Global prevalence rates were 56.3% for high emotional exhaustion (EE), 55.3% for high cynicism (CY) and 41.8% for low personal accomplishment (PA). Prevalence of EE, CY, and PA domains varied significantly across fields of study, countries and WHO and World Bank regions, but not sex. All studies demonstrated good internal validity, although substantial heterogeneity existed between studies. The certainty of evidence was rated as moderate. Considering its potentially severe consequences, burnout is a significant public health concern. The development and implementation of evidence-based localized interventions at organizational and individual levels are necessary to mitigate burnout.